As in other nonneoplastic CNS lesions, the presence of macrophages on intraoperative cytologic preparations should suggest the diagnosis of radiation necrosis over recurrent tumor

Differential diagnosis

Recurrence of the tumor for which the patient received radiation therapy (typically glioblastoma): features which favor radiation therapy effect include a lack of peripheral pseudopalisading of cells around areas of necrosis, the presence of associated microcalcifications and hyaline thickening of blood vessels

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